Scary stuff indeed - Against all the static of war and terrorism, it would be sadly ironic if we look back at this under-reported story as the beginning of the end... (must remember to inject just heroin)posted by jalexei at 3:50 PM on November 12, 2002

it's the end of the world as we know it, and i feel fine.
of the people that i know who have been to hospital recently, at least half had their stay increased due to mrsa.
'if you are not part of the solution, you are part of the problem', as they used to say.posted by asok at 3:57 PM on November 12, 2002

I, for one, welcome our new antibiotic-resistant prokaryotic overlords.posted by kickingtheground at 4:02 PM on November 12, 2002

This is exactly why i use only pasteurized heroin.posted by shoos at 4:04 PM on November 12, 2002

The current issue of JAMA has a story about a 2nd case of VRSA, this time in Pennsylvania.posted by shoos at 4:12 PM on November 12, 2002

it reminds me of 'the war of the worlds' (spoiler).
(more spoiler) as i remember it, in the original the martians are killed by a bacteria, in hollywood film1 by a bacteria sent from god and in hollywood film2 by a computer virus delivered whilst the president gives air support in a fighter plane, or something.anyhoo, the bacteria thing.posted by asok at 4:23 PM on November 12, 2002

the little bugs seem to evolve much more quickly than humans own immune systems.

Possibly because we're not using our immune systems... we're using medical science, and that doesn't seem to be working at the speed that natural selection/evolution does in bacteria.

My question is: as a person who hasn't used anitbiotics in three years, do I get stronger if I weather an infection -- do I personally become more resistant? Should we watch those who develop infections, and only intervene with antibiotics if it becomes clear the body is losing? Or is that a formula for just letting people die....?posted by namespan at 4:37 PM on November 12, 2002

Dumb thought from nonexpert:

Once the next last-line-of-defense bacteria-killer is deployed (assuming that happens), wouldn't the thing to do be to shelve grampa penicillin for fifty years or so, and so on with the next oldest drug, letting the nasty bacteria lose their resistance to the old drugs while they evolve to deal with the effects of the new ones? I mean, in practice I'm sure it'd be more complex - I don't know how many different working general-purpose antibiotics we have for starters - but you get the gist. Or is that unworkable? Link number 4 of WolfDaddy's post alludes towards the "permanence" of antibiotic resistance in that bacteria spread their resistance to daughter cells etc. but it doesn't much get into whether the bacteria are able to keep up unneeded resistances over many generations.posted by furiousthought at 5:00 PM on November 12, 2002

As far as I'm concerned, the people who overprescribed antibiotics, who pushed their use for acne, who feed them to livestock in bucketfuls -- these people are worse enemies of humanity than any terrorist ever could be.posted by Slothrup at 5:01 PM on November 12, 2002

Actually, this is not the first bug to become Vanco resistant. We already have VRE (Enterobacter) but this is the first staph that is resistant. The scarry thing is that a healthy 38 year old friend of mine was hospitalized this summer with what he thought was a spider bite on his hand. It turned out it was MRSA and he had to undergo two surgeries and IV Vanco. He's a stage electrician, where the hell did he pick up MRSA?posted by whatever at 5:47 PM on November 12, 2002

One possible source of the vancomycin resistance in Detroit and Pennsylvania came from European cattle.

How it may have gone:
1. Cattle in Europe are fed a drug very similar to vancomycin, called avoparcin, between 1974 and 1997 (banned by EU in 1997)
2. Enterococci in cattle develop resistance to avoparcin and consequently to vancomycin.
3. Resistant Enterococci spread throughout humans in Europe.
4. Resistant Enterococci spread from Europe to US.
5. Enterococci "conjugate" (a sort of bacterial sex) with Staphylococci in US, creating vancomycin-resistant staph.

Steps 1-3 are known to have happened. Step 4 is considered by many scientists to have happened, and Step 5 very possibly happened, but it's not known yet.

whatever, MRSA is now becoming a more frequent community-acquired organism; it's no longer shocking for doctors to find that an otherwise immunocompetent, non-chronic patient has an infection with MRSA. It's damn sad, too.

There's a good article in today's NYT that describes part of the reason why this happens: there's pretty much uncontrolled (and uncontrollable) access to many antibiotics from the bodegas and community pharmacies in much of poorer New York City. Immigrants, who are used to being able to buy ampicillin, penicillin, and other antimicrobial elixirs over the counter in their home countries, have managed to import that behavior into their neighborhoods here, and that means that it's a rare thing to find bacterial infections that respond to the first-line antibiotics anymore.

The funniest thing is that vancomycin is actually a pretty crappy antibiotic; the first-line antibiotics are all much more effective bacteria killers when the bacteria haven't developed mechanisms of resistance. Likewise, the alternatives when vanc-resistance rears its ugly head -- linezolid, for one -- aren't all that great at what they do, they just shine because they represent the only option for those circumstances.

My question is: as a person who hasn't used antibiotics in three years, do I get stronger if I weather an infection -- do I personally become more resistant? Should we watch those who develop infections, and only intervene with antibiotics if it becomes clear the body is losing? Or is that a formula for just letting people die....?

You do personally become more resistant yes, but that is not an evolutionary adaptation, meaning you children would not be more resistant. I think that idea would be good, but more people may die yes. Also, if you are sick and you take antibiotics that doesn't stop your immune system from adapting to the new bacteria/virus/etc, so it's not an either or thing.

Once the next last-line-of-defense bacteria-killer is deployed (assuming that happens), wouldn't the thing to do be to shelve grampa penicillin for fifty years or so, and so on with the next oldest drug, letting the nasty bacteria lose their resistance to the old drugs while they evolve to deal with the effects of the new ones?

Bacteria actually do lose their resistance very quickly, certainly not as long as 50 years, more in the range of bacterial generations which are of course very fast. If you think of it in terms of natural selection it makes sense. If you are growing staph in antibiotic-a then the ones that pump out antiboitic-a will have an advantage, if however you take out the antibiotic the ones that aren't wasting energy making the pumps to pump out nothing will have the advantage. With a replication rate as fast as bacteria this impacts the population very quickly.

Why this doesn't work so well is that each adaptation the bacteria do are very different due to how evolution works. Maybe for penicillin it will make an enzyme that breaks the molecule in half, and for another antibiotic it creates pumps that pump it out, perhaps another would alter the cell permeability so that the antibiotic can't enter, and yet another would alter the target in the bacteria so that the antibiotic has no effect. These changes will create different overlaps in which antibiotics the bacteria is coresistant to. If you make an enzyme that breaks penicillin, and the antibiotic changes, but still has the same ring structure maybe the enzyme still works. If you pump out [anything similar to x] then the bacteria might become multiply resistant... Also, it's not like the bacteria can only do one thing to defend themselves, if they're in a hospital with constant bombardment with different antibiotics maybe it's better to just express the whole block of multiple resistant genes it picked up from that enterococci from that waiter who didn't wash their hands... :P

That was long... Also, you have to consider the public health issues, you can't just say, stop using X antibiotic because that would have to be enforced globally. Would you choose the oldest ones to stop using, since they are the most prone to resistance? They are also the cheapest, and they do work quite well for that poor girl dying in southeast asia...posted by rhyax at 6:28 PM on November 12, 2002

This is only the logical progression of a problem that has been around since the second species of life evolved. Others above are exactly right about some of the proximate causes of this problem; remember that the next time you ask your physician for an antibiotic or ignore the feeding of antibiotics to livestock in favor of more fashionable causes like BGH in milk. Another issue is the fact that current methods of funding drug research encourage the development of "me too" drugs at the expense of basic science research that would discover whole new classes of drugs. But hope is not lost; bacteriophages and peptides both show promise. Also important to remember (and many medical people seem to forget or not know this) is that these so-called supergerms are complete wimps when it comes to survival outside of a hospital or other unnatural environment. The same mechanisms that confer resistance to antibiotics are merely wastes of precious ATP (the source of energy for cells for you non-biologically oriented) when the bacteria are not in an environment that selects for antibiotic resistance (in other words, when antibiotics are not around). They are quickly overwhelmed by "normal" bacteria in a classic example of evolution in action.

Despite these rays of hope, I am troubled by every report of a new resistant bacterium. Antibiotics should be as tightly regulated as narcotics and not poured recklessly into the environment.

Sorry for the long post, but this is a soapbox I think is important to stand upon.posted by TedW at 6:36 PM on November 12, 2002

Missed it on preview, but rhyax is right on target and made some points I was aiming for better than I did. Another thing to remember is that even without resistance, antibiotics are not equally effective against all bacteria, so shelving certain antibiotics for a time is only a partial solution in that regard, as well as for the reasons rhyax states.posted by TedW at 6:40 PM on November 12, 2002

...we're not using our immune systems... we're using medical science...

Not exactly. Antibiotics don't take the place of the immune system, they're believed to work by bringing the bacterial load down to a point where your immune system can deal with it, they don't wipe out all the bacteria, they wipe out some, and your immune system wipes out some.

That said, people (and doctors) who abuse antibiotics will be the first against the wall when the revolution comes (assuming there's anyone uninfected left to have a revolution with, that is).posted by biscotti at 6:46 PM on November 12, 2002

Antibiotics should be as tightly regulated as narcotics and not poured recklessly into the environment.

There you go. Succinctly summarizes exactly what needs to happen.posted by CoolHandPuke at 7:00 PM on November 12, 2002

rhyax: I'd think that for resistance genes carried on transposons, the persistence would be quite long. Most organisms, including bacteria, carry loads of unnecessary crap in their genomes. Why couldn't an antibiotic resistance gene within a transposon hang around the bacterial genome for a thousand+ years? There might be a short lag phase to get the resistance gene spread back throughout the population after a number of years without the corresponding antibiotic, but probably not that long.posted by shoos at 7:05 PM on November 12, 2002

actually bacteria don't have so much junk dna, certainly not approaching as much as humans. For bacteria any extra dna is very bad, they replicate very quickly. If you can cut an "expense" then you will replicate faster and become dominate. multicellular life is much slower, we react, and are lumbering, even on a cellular level, compared to bacteria.

your 4th sentence though I agree with, when i say it's out of the genome i mean the consensus genome for a species, that is not the same as gene pool, or population. i don't know of how quickly a resistance gene would become widespread if it were in the population at .001% rather than .00001% etc. If i was unclear I wasn't saying that the hold-a-antibiotic-back plan would work.posted by rhyax at 7:44 PM on November 12, 2002

If you can cut an "expense" then you will replicate faster and become dominate.

The same applies to a transposon. Bacteria feed off of transposons (by, among other things, using the products of their resistance genes) and transposons feed off of bacteria (by using them as hosts in which to replicate). To keep their host cells from replicating more slowly or otherwise being less evolutionarily fit in their presence, transposons have their own tricks up their sleeves - like temporarily shutting off their own expression or by increasing genetic diversity in the host cell by facilitating recombination or gene inactivation.

They are just pieces of DNA, but that doesn't mean they're stupid.posted by shoos at 8:14 PM on November 12, 2002

Overuse or over-prescribing of antibiotics is a problem, but then so are those who become irritated and upset with their healthcare provider for resisting their demands for said prescription.

Modification of patient behavior wrt antibiotics has received some attention in medical journals and physicians are being counseled by the hospital where they practice on the issue.

The amount of times I have heard "I took it for a couple of days and felt better, so I stopped taking it," "I had some of X left over from before, so I took that" in spite of the directions to take all the pills even when you begin to feel better boggles the mind!posted by sillygit at 8:54 PM on November 12, 2002

Thank you rhyax. (TedW, shoos too.) Very eenteresting. I nearly forgot about this thread after I started fishing for explanations, but I'm glad I didn't. I like it when Metafilter makes me smarter.posted by furiousthought at 9:54 PM on November 12, 2002

It's not just antibiotic medications that are affecting (effecting?) the evolution of bacteria. Think of all the soaps, cleaners, plastics, etc that are now full of 'antibacterial' stuff.

Bacteria are adjusting to every little antibacterial thing we throw at them. It's not like we need all of this anyway. Your best bet is regular soap, normal products, and cleaners.

Of course, the germ phobic aren't thinking ahead to what they are doing to all of humanity.posted by SuzySmith at 2:25 AM on November 13, 2002

the little bugs seem to evolve much more quickly than humans own immune systems

Maybe because they go through hundreds of generations in a week (or however long-- biology isn't my strong point)?posted by yerfatma at 5:11 AM on November 13, 2002

Can I put in my tuppeneth?

Maybe I'm just going all morbid, but I can't help feeling that maybe there is a point to these bugs. Human beings have flooded this world and are massively overdue for a big killer bug to wipe the population out. The world needs to get rid of some of us.

While none of mine get attacked by the bug, I'd be tempted to say it's a good thing. Of course, as soon as someone I know gets hit by it I will change my mind... ;)posted by twine42 at 5:39 AM on November 13, 2002

Antibiotics should be as tightly regulated as narcotics and not poured recklessly into the environment

good luck fighting the pharmaceutical lobby on this one with Bush in the White House, lol.posted by zoopraxiscope at 5:52 AM on November 13, 2002

>> Antibiotics should be as tightly regulated as narcotics
>> and not poured recklessly into the environment
>
> good luck fighting the pharmaceutical lobby on this one
> with Bush in the White House, lol.

Good luck regulating all the factories/labs worldwide (large, small, and kitchen-sink) that have the capability of making antibiotics. Also, good luck regulating all the people who won't see any other aspect to the issue besides "it's my body and I have the right to put anything into it that I want."posted by jfuller at 6:35 AM on November 13, 2002

jfuller: yes, but it works so brilliantly well for cocaine - surely the same principle can be applied to dangerous drugs like penicillin, too.posted by Mars Saxman at 7:37 AM on November 13, 2002

Detroit rules, man. We've got all the tough shit here. You can bet that if there's a bad ass bacteria, it's gonna show up in Deetroit.posted by pardonyou? at 7:56 AM on November 13, 2002

Maybe I'm just going all morbid, but I can't help feeling that maybe there is a point to these bugs. Human beings have flooded this world and are massively overdue for a big killer bug to wipe the population out. The world needs to get rid of some of us.

That sounds like anthropomorphism. No intention is at work here but survival. We're really not so different, but obviously humankind has just about the widest niche to survive in, which makes us more of a threat. AFAIK we aren't the first species to "cause" extinction events: just very prolific.posted by walrus at 9:14 AM on November 13, 2002

What will all those people who don't believe in evolution think about this? Their only conclusion will have to be, that GOD is making these bad ass bacteria to punish us.posted by ollybee at 12:07 PM on November 13, 2002

"Also important to remember (and many medical people seem to forget or not know this) is that these so-called supergerms are complete wimps when it comes to survival outside of a hospital or other unnatural environment."

It isn't not scary. Jeff Goldblum had a good line in Jurassic Park that sums it up well: "life will find a way." And bacteria are certainly finding theirs.

What makes it slightly less scary is that humans have brains that allow them to devise ways of protecting themselves from things like that. The potentially good thing about these stories though is that word will spread that something needs to be done. Ie, antibiotics need to be more wisely administered and there needs to be more research done towards developing new antibacterials.posted by shoos at 1:39 PM on November 14, 2002

And about "supergerms" being "wimpy,"

Wimpy strains would be happy to donate their resistance genes to more macho strains given the opportunity.posted by shoos at 1:43 PM on November 14, 2002

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